Blog Archives
By Hannah Lambalot | Categories: | Comments Off on Food Pharmacy
The Food Pharmacy originally began as a food pantry, but like most essential hospitals this meant the demand may outstrip the NGH Foundation’s funding resources to maintain the program. Hence, Nashville General Hospital focuses on patients with food insecurity who also have a diagnosis of chronic illness or cancer. The goal is to provide prescribed food supplementation to the patient’s diet which offers education for long term food choices for chronic illness self-management or completion of infusion services.
Patients are identified through the emergency department, outpatient clinic, inpatient dismissal or oncology infusion services. The NGH Foundation is currently funding all of the food, staffing needs, and recruiting community volunteers through grants. The hospital is providing in-kind, the Food Pharmacy square footage, care management team members for some education, dietary staff oversight, and the infrastructure of the referral departments to recommend patients.
The program relies on patient flow from the emergency department, outpatient, inpatient, and oncology. Additionally, patient outcomes for diabetes, hypertension, and oncology compliance with the Food Pharmacy are tracked through clinics and oncology. External community partners provide food, volunteers and funds.
Early results for oncology patients using the Food Pharmacy for the past three years reveal 100% of patients on the program maintaining or gaining weight – preventing pause in chemo services due to toxicity. Outcomes for chronically ill patients is still too new to offer reliable data until January 2020.
By Jamie Cetrone | Categories: | Comments Off on Food as Medicine
Cuyahoga County, home to The MetroHealth System, ranks highest in Ohio for the greatest number of food insecure adults and children. To impact health outcomes for patients identified as food-insecure and who have chronic health conditions, MetroHealth opened a new food clinic, with a pantry, “Food as Medicine,” on their main campus. The Food as Medicine Clinic is a targeted food-based intervention designed to address food insecurity as a social determinant of health, and improve health outcomes for patients with certain chronic health conditions that are common in MetroHealth’s patient population and are impacted by diet.
The Food as Medicine clinic works on a referral basis, where MetroHealth case managers and social workers refer patients based on a food insecurity screen and medical criteria. Patients enrolled in the pilot program must screen positive for food insecurity at the time of hospital discharge, have a primary care physician at MetroHealth, and have uncontrolled diabetes, uncontrolled hypertension or acute exacerbation of heart failure. Once prescribed, patients can select a two-to-three-day supply of healthy foods for themselves and family twice a month, stocked by the Greater Cleveland Food Bank, which include whole grains, dairy, fresh and frozen produce, canned fruits and vegetables, and meat products. Additionally, a diet technician will provide nutritional education and assistance in the clinic, along with information about healthy cooking. For patients in need of transportation assistance, a bus or parking pass can be provided to and from the clinic. The pilot phase of this program aims to serve 100 patients.
Citizen’s Bank, through their Citizens Helping Citizens Fight Hunger program, provided the initial investment to help develop the Food as Medicine pilot program and food clinic. Additional funds have been received from Mt. Sinai Health Care Foundation and The Reinberger Foundation who have recently approved two-year grants to support and sustain the program. The Greater Cleveland Food Bank continuously stocks the clinic’s pantry. Students pursuing nutrition-related degrees from area colleges provide volunteer support for the program.
MetroHealth is starting with a 100-person pilot to measure the effects of the Food as Medicine intervention on eating habits, particularly fruit and vegetable consumption, healthcare utilization (hospitalization and ED visits), and clinical measures such as hemoglobin A1c, blood pressure, and BMI. This is a relatively new program and still in the enrollment phase; MetroHealth is just beginning to collect 3-month follow-up surveys to assess preliminary outcomes.
By Jamie Cetrone | Categories: | Comments Off on Flavor Harvest@HOME
Studies indicate that as many as 1 in 3 patients 65 or older are at risk for malnutrition upon admission. Without proper treatment, approximately 2/3 of malnourished individuals will experience further decline in their health status due to increased risk of infection, pneumonia, etc, which is then posing financial risk to the health system.
In late 2013 Lee Health System assessed their treatment of malnourished patients, and identified that only 1.3% were diagnosed as malnourished. Knowing that 45% of patients were 65 or older, they recognized a need to change the way they address this medical need. Initially the program was piloted at one hospital, and once outcomes were validated it was expanded to all acute and post acute facilities. The primary goal of the program is to assist patients in their recovery by facilitating their transition from Acute Care to Self Care through the provision of appropriate nutrition, which when properly administered has proven to improve recovery, limit costs, and reduce readmission rates.
Flavor Harvest@Home is an in home medical nutrition therapy program designed to provide nutritional support for the home bound patients who are either diagnosed and/or at risk for becoming malnourished. Flavor Harvest@Home provides therapeutically appropriate meals to home bound patients recently discharged from the hospital delivered to their doorstep for 4 weeks free of charge. A full array of therapeutic meals covering all meal periods, snacks and beverages are available to patients either through direct intervention by their caregiver or a nutrition call center.
Flavor Harvest@Home is part of a 4 component nutritional intervention plan designed to improve patient recovery times. Incorporating many of the Alliance for Advanced Nutrition’s multidisciplinary Nutrition intervention framework, the program includes: (1) nutrient dense food and/or nutrition home meal delivery, (2) nutrition education for clinical providers for better identification of malnourishment risk, improved screening tools and increased nutrition assessment, (3) nutritional counseling with patients and families, and (4) coordination of nutritional care during and after hospital discharge. The Flavor Harvest@Home project is designed to measure the effectiveness of an enhanced interdisciplinary nutrition intervention program on targeted hospital patients with a state of malnutrition or at risk for malnutrition.
This model is a multidisciplinary effort that requires coordination with clinical professionals, registered dietitians, providers, food service staff and third-party contractors.
Readmission rates in the program participants continue to show improvement. Between 2015 and March 2017, 1,259 patients qualified for the program. To date, over 1500 patients have completed the full 4 weeks of meals.
By Jamie Cetrone | Categories: | Comments Off on Lee Memorial Health System
By Jamie Cetrone | Categories: | Comments Off on Delivering Community Benefit: Healthy Food Playbook
By Jamie Cetrone | Categories: | Comments Off on Vita Health and Wellness District
In 2000, Stamford Hospital (SH) partnered with Charter Oak Communities (COC) to expand and redevelop their respective real estate holdings on Stamford’s West Side. The 2013 Community Health Needs Assessment (CHNA) identified the neighborhood as a priority due to its disproportionate share of chronic diseases. The CHNA results, along with the Affordable Care Act’s emphasis on addressing the upstream causes of disease, prompted Stamford Hospital to undertake a series of strategic investments in the surrounding community. Stamford Hospital and COC crafted a unique exchange of owned properties that enabled both to complete a series of complex redevelopment projects, including a new hospital and hundreds of housing units. This relationship led to the Vita Community Collaborative in 2012, which aims to promote health and wellness in the West Side neighborhood. Vita developed an interactive tool, entitled Vita Impact designed to show the linkages between targeted social initiatives and other characteristics that can broadly impact a community.
The Vita Health and Wellness district has become a health-themed neighborhood where numerous distressed public housing projects have been replaced with lower-density, mixed-income communities with dedicated resident support services, public green spaces, an independent pharmacy, and a revitalized hospital and campus. Each aspect of Vita addresses the social determinants of health, including healthy housing, economic stability, education and attainment, public health and access to medical care, physical activity and improved social cohesion. The core of Vita includes hundreds of new mixed-income, townhouse-style communities (with more under construction). Vita’s unique volunteer-powered urban farm (www.FairgateFarm.com) hosts numerous community-building programs such as nutrition education, cooking classes, food waste composting, and food security. Residents of the Vita community are afforded access to non-emergent medical care with two federally qualified health centers (FQHCs) serving patients on Medicaid and Medicare along with the underinsured, and the Americares Free Clinic, which provides primary care for uninsured patients who do not qualify for any government funded programs. Stamford Hospital supports the entire Vita initiative by contributing to its operating budget and providing dedicated in-kind staff support.
Stamford Hospital and Charter Oak Communities provide the essential backbone support to the Vita initiative, which includes program management, administrative services, communications and public relations, program evaluation, fund raising and strategic leadership. Vita Collaborative members represent nearly every discipline among community organizations including healthcare, public health, mental health, human services, education, food security, affordable housing and local government representation. Stamford Hospital also provides nutritionists, data analysts, and clinical staff to participate in planning and program implementation. Stamford Hospital completed construction on its new hospital and redeveloped campus, investing $450 million, and Charter Oak Communities has completed nearly 400 units of mixed-income housing through its strategic application of public and private resources – totaling an investment of over $200 million.
Each year, Fairgate Farm engages hundreds of participants and volunteers including students of all ages, corporate and civic volunteers, gardening enthusiasts and ‘foodies’, and numerous local residents. In 2017, the Farm grew over 4,000 pounds of organic fruits and vegetables, donating much of it to local hunger relief organizations. The Parents-as-Co-Educators program, designed to improve Kindergarten readiness for children of immigrant families, had a 100% success rate in its 2015-2018 cohort. This program has been rigorously measured through its partnerships with the Harvard Business School Community Partners and the University of Connecticut. A second cohort is planned to begin in the fall of 2018.
By Jamie Cetrone | Categories: | Comments Off on Spartanburg’s Way to Wellville
In 2015, Spartanburg was one of five communities in the nation chosen to participate in the Way to Wellville; a challenge to develop new and innovative solutions that amplify and accelerate community health. Sponsored nationally by HICCup, Spartanburg’s Way to Wellville is working to improve health outcomes through five focus areas in the City of Spartanburg: obesity prevention; kindergarten readiness; access to care for the uninsured; health for the insured; and community pride.
A Core Team of cross-sector leaders serves as the key navigator for Spartanburg’s Way to Wellville. This leadership group monitors progress, supports committees in meeting their goals, and explores and evaluates other potential partnerships and related opportunities. Way to Wellville committees create goals and develop specific projects and programs for each of the five focus areas. The hospital and participating organizations leverage resources and equally share the expenses of the Coalition. Although the Way to Wellville focuses on all residents in the City of Spartanburg, particular emphasis is placed on the vulnerable and the very young.
Hospital leadership sit on the core team and look for multiple ways to include the health system in the work. Programs working to find access for the uninsured, a small business wellness cooperative, home visitation programs for new moms…..all involve the health system in some way.
The Way to Wellville explores innovative and creative ways to address critical health issues in the City of Spartanburg. Examples include:
- A major initiative to introduce nine programs that would be available to all new mothers and the 650 babies born in the city each year is underway. From home visitation to parenting classes to quality early learning, they are working on a pay-for-success model of financing and look forward to rolling out in 2019.
- A prototype of a small business wellness cooperative is currently being built and a pilot will launch mid- 2018. This will allow small business owners to provide similar resources to their employees that large employers do.
By Jamie Cetrone | Categories: | Comments Off on Henry’s Groceries for Health
Gleaners and Henry Ford Health System recognized an opportunity to improve the health of patients who are already high-risk clinically (multiple chronic conditions) and are screened positive for food insecurity. Case managers in three high-risk clinics screen patients for food insecurity and eligibility, and patients who accept enrollment in the program are offered a package of food (including fresh produce and frozen meats) every two weeks for six months. The pilot will enroll 300 patients total, with expansion based on success. Measures include ED visits, admissions, and readmissions experienced by the enrolled population.
The program scope includes the patients currently being seen in three Henry Ford Medical Group clinics across Southeast Michigan, including two in the City of Detroit. Case managers already support these clinics, so no new staff resources were required. Gleaners receives lists of patients to receive food deliveries (for patients at two of the clinics) or food pick-up (for patients in the third clinic). Funding is handled through existing Patient Needs Fund, covering the cost of the food and delivery for the patients.
HFHS Public Health Sciences assisted with the software to send patient information in a de-identified way to Gleaners. HFHS legal team assisted with ensuring a Business Associate Agreement. The Gleaners senior team meets with the HFHS program team weekly to track progress in the pilot.
The program launched in the three clinics on 11/15/17. As of 1/8/18, 575 patients have been assessed, of which 118 (20.5%) have been identified as food insecure. Some of these patients proved ineligible for the program due to extensive dietary restrictions, in-home cooking limitations, or family size, bringing the total eligible to 100 (17.5%). Of these, 100% have accepted the program, and only three have subsequently dis-enrolled for various reasons.
By Jamie Cetrone | Categories: | Comments Off on Veggie Mobile
The Regional Environmental Council (REC) developed the Grant Square Community Garden in 2010 with support from UMass Memorial Medical Center and the City of Worcester. It has 30 raised beds maintained by the REC YouthGROW program and neighborhood residents. The youth tended garden generates between 500-800 pounds of produce for the neighborhood and 15 stops in food-insecure areas across the city through REC’s “Veggie Mobile” mobile farmers market, including three stops in Bell Hill. Medical Center funding doubles the value of food stamps for purchase at the Veggie Mobile.
UMass Memorial Medical Center partners with the Worcester Regional Environmental Council (REC) to bring fresh produce to low-income/food-insecure neighborhoods through the Veggie Mobile program. Funding provided by UMass Memorial Medical Center to the Worcester Regional Environmental Council doubled SNAP purchases on the Veggie Mobile. REC’s Food Justice Program works to increase access to nutritious, healthy, and locally grown food in Worcester’s food-insecure neighborhoods, including Bell Hill where the UMass Memorial campus is located. REC programs encompass a community garden, three school gardens, a YouthGROW urban farm, and the Veggie Mobile which makes 15 weekly stops in all five of the Neighborhood Revitalization Strategy Areas identified in the city.
Since 2012, SNAP and EBT purchases on the Veggie Mobile have increased from 30% of sales, to 90% currently. Total purchases have increased by 300 percent.
By Jamie Cetrone | Categories: | Comments Off on Hurley Medical Center Food FARMacy
After reviewing other hospital programs which address social determinants of health (via America’s Essentials Hospitals and Advisory Board), Administrator of Population Health, Alisa Craig, developed a strategy that was approved by Hurley Senior Leadership. This resulted in hospital-wide screening (2-questions) for food insecurity and referral to the Food FARMacy (opened 8/1/17) if screening was positive. Hurley Medical Center’s (HMC) vision is to expand beyond the walls of the hospital to provide the best possible care to our community. By truly treating “hunger as a health issue”, Hurley is taking an important step in addressing social determinants of health within very vulnerable populations. With the rate of food insecurity being higher in Genesee County than the national average, addressing this issue proactively will have a tremendous impact on a patient’s ability to manage a chronic disease or fight illness. This is extremely important in children and older adult populations who have high rates of food insecurity. Hurley Medical Center’s Food FARMacy addresses the issue of food insecurity in their patient population by increasing access to healthy foods and providing them with additional resources to assist them long-term.
In August 2017, Hurley began screening for food insecurity (within their electronic medical record – EPIC) and providing referrals to the newly opened Food FARMacy. Upon discharge from inpatient units or outpatient primary care clinics, a patient who gets this referral can get nutritious food for themselves and their household members, twice per month, for three months. The food provided is tailored based on their health needs, chronic conditions, and allergies. The patients have the opportunity to meet with a Registered Dietitian while at the FARMacy, and are given community resources for longterm support. Assistance is provided to make sure the patients are appropriately enrolled in benefits such as SNAP, WIC, and Double Up Food Bucks.
By addressing their food insecurity, patients will be able to better manage their chronic conditions, not have to make as many financial “trade-offs” (like having to choose to pay for medicine vs. food), and may have improvements in health status. Hurley provides the physical space for the Food FARMacy, which is co-located within the Adult Diabetes Center. Funding for a part-time dietitian and food comes from a Community Foundation grant. Program staff work closely with the IT department (EPIC) to establish the screening/referral/reporting process.
Collaboration is key, both internally and externally. The EPIC (EMR) team is crucial in this project, and staff has engaged all levels of nursing, nursing management, nursing education, residents, and the GME dept. Externally, staff work very closely with the Food Bank of Eastern Michigan to get most of the food. They also supplement via local gardens (MSU-E Edible Flint) and growers. Volunteers come from the hospital’s foundation volunteer services, students from the MSU School of Human Medicine’s Leadership in Medicine for the Underserved, and AmeriCorps team members via Pediatric Public Health Initiative. Funding is provided from the hospital, hospital foundation, and the Community Foundation of Greater Flint.
Funding through the Community Foundation of Greater Flint;
To date, close to 800 people have received food from the Food FARMacy, with new patients being referred daily. The need is great, and they have already seen a 35-53% Food Insecurity rate in primary clinic settings. In addition, the program has helped several patients get appropriately enrolled in nutrition assistance programs. Program staff hope to have more specific data, related to health outcomes, to share by July 2018.
